Karen Nolan: Health-care crapshoot

I read Steven Brill's excellent overview of U.S. health-care costs ("Bitter Pill: Why Medical Bills Are Killing Us," Feb. 20, Time magazine) a few weeks after spotting a news item about the CALSTAR membership program, and I can't help but connect the two.

Among the points Brill makes is that there is often little relationship between what a medical service actually costs and the amount the service provider charges.

I had been pondering that very idea since reading the Feb. 10 article about CALSTAR, the nonprofit air ambulance that flies out of Vacaville's Nut Tree Airport.

The article reminded families that they could become CALSTAR members for $50 a year -- or $35 if they work for a business or belong to an organization that has persuaded at least 15 families to sign up.

What to do they get for joining? Perhaps a chance to avoid bankruptcy.

According to the announcement, "a typical CALSTAR flight can cost anywhere between $25,000 and $30,000. ... While some insurance companies pay for air medical transport in full, the average insurance company typically pays 50 percent to 60 percent of the bill, leaving the patient to pay the balance.

"If anyone in the family is a CALSTAR member, the air ambulance will accept insurance reimbursement as payment in full. If the individual doesn't have insurance, CALSTAR will not bill the member."

Think about this: CALSTAR says it costs $25,000 to $30,000 per flight, yet it is willing to fly an otherwise uninsured patient for $35, providing he or she paid in advance.

Similarly, it is willing to serve an insured patient for whatever the patient's insurance company agrees to pay.

It occurs to me that it might be cheaper if nonprofit insurance companies (technically, they are "organizations") signed up all of their insured families for $35 a year and dropped their air ambulance coverage completely.

Of course, CALSTAR isn't the only air ambulance around, and that makes membership a bit of a crapshoot. In the event that you need an air ambulance -- and, really, how often is that likely? -- there's no assurance that you could stipulate which one you'd ride in.

And that brings up another point of frustration: If you require an air ambulance, chances are you won't be in any condition to give your consent -- much less an informed consent -- to a service that could end up costing you $25,000 or $30,000.

Of course, that's also true about the costs you'll incur at the hospital. But I digress.

CALSTAR's membership plan reminds me of the fire insurance subscription services that still exist in some communities. We read about them when someone's house burns to the ground while firefighters stand around watching because the homeowner hadn't bothered to pay their fees.

What we've forgotten is that those subscription services used to be the norm, before people decided that it was safer -- and cheaper in the long run -- if everyone was required to pay a little to provide fire service for the whole community.

Maybe it's time to start thinking that way about health services, too.